Breast

Question 1

Commonest cause of bloody nipple discharge in pts 20-40yo?

Answer 1

Intraductal papilloma

Question 2

Triple assessment to exclude CA from fibrocystic change?

Answer 2

Hx & Clinical exam
Imaging
Histopathological assessment (biopsy)

Question 3

Hormonal factors for breast CA?

Answer 3

Early menarche <12yrs
Late menopause >55yo
Late 1st childbirth
Hormone replacement therapy
Nulliparity

Question 4

Blood stain/spot on bra?

Answer 4

Paget’s or Dermatitis/Eczema

Question 5

Fibroadenomas arise from?

Answer 5

terminal duct lobular units

Question 6

Breast infection divided into?

Answer 6

Lactational or non-lactational infection

Question 7

Causes of microcal in mammograms?

Answer 7

DCIS
Invasive CA
Fibrocystic disease
Papilloma

Question 8

Defining feature of microcal for diagnosis?

Answer 8

Microcals in straight line = DCIS
Scattered Microcals = Fibrocystic disease

Question 9

Cause of stellate lesion with poor outline or comet sign?

Answer 9

Invasive CA, radial scar (benign), fat necrosis, abscess

Question 10

1st investigation for young pts <35 and pregnant/lactating pts?

Answer 10

Ultrasound.
Cuz they have denser breasts hence easier to evaluate with US than MMG

Question 11

DCIS definition?

Answer 11

Malignancy from terminal dut-lobular unit. Preserves myoepithelial cell layer.
PRE-INVASIVE BREAST CA

Question 12

Paget’s associated with?

Answer 12

Underlying DCIS or invasive CA in 85-88% of cases.

Question 13

Level 3 axillary LNs are where?

Answer 13

Medial to pec minor

Question 14

Level 2 axillary LNs where?

Answer 14

Posterior to Pec minor

Question 15

Level 1 axillary LNs where?

Answer 15

Lateral of Pec minor

Question 16

Fibrocystic Changes of breast?

Answer 16

Cysts & Apocrine metaplasia
Epithelial hyperplasia
Fibrosis
Adenosis

Question 17

Features of Fibroadenoma?

Answer 17

Firm well defined mobile tumour, slow growing

Question 18

Milk discharge 1 year after stopping breastfeeding. Isit normal?

Answer 18

No

Question 19

Brownish discharge suggests?

Answer 19

Ductal ectasia

Question 20

Bloody discharge should be investigated via?

Answer 20

MMG, US, FNAC

Question 21

Which growth cannot be seen on MMG?

Answer 21

Papilloma. Too small. Can cause nipple retraction

Question 22

Green / Black / Brown nipple discharge means?

Answer 22

Mammary ductal ectasia. Due to cell debris

Question 23

Who gets puerperal abscesses?

Answer 23

Primiparous mothers

Question 24

Who gets non-puerperal abscesses?

Answer 24

Commonest non-breastfeeding abscess. Seen in young women, esp smokers

Question 25

Treatment for mammary ductal ectasia?

Answer 25

None, usu self-limiting

Question 26

Fibroadenoma?

Answer 26

Common in young women. Sometimes regress spontaneously

Question 27

What raises risk of breast CA?

Answer 27

Higher estrogen exposure: Early menarche, OCP, late 1st pregnancy, nulliparity, late menopause, white ethnicity etc.

Question 28

How to differentiate breast abscess and mastitis?

Answer 28

Breast abscess is fluctuant, mastitis is not

Question 29

Breast CA screening?

Answer 29

40-49 every year 50 and above every 2 years

Question 30

What drug for endocrine hormone therapy for early breast cancer?

Answer 30

Tamoxifen. Estrogen receptor is a good predictive marker for response to endocrine therapy

Question 31

How often to screen for cervical cancer?

Answer 31

25-29yo every 3 years >30 years, every 5 years

Question 32

Mammogram screening guidelines?

Answer 32

Yearly from 40-49 years. Biannually from 50 onwards

Question 33

Why screen yearly for mammogram from 40-49 years?

Answer 33

Breast tissue is denser at 40-49 compared to > 50 years. Hence it is less specific and sensitive. Hence want to screen more often to be safe. Actually 40-49 years dont rly have to screen unless got risk factors. | 25% of breast cancers can be missed through mammogram at 40-49 years

Question 34

How to screen for breast stuff below 40 years?

Answer 34

Do ultrasound straightaway. Breast tissue is too dense to evaluate with mammogram